Sacral chordoma Outcomes and management

Chordomas have shown to have a poor sensitivity towards radiotherapy and chemotherapy, therefore surgical resection has been the primary treatment; a – even for the most experienced surgeon – challenging and complex undertaking. Part 1 of this thesis is devoted to learning more about outcomes (survival, recurrence, metastases, and quality of life) and variation in management. We found that a combination of surgical resection and adjuvant radiotherapy resulted in good overall survival, local relapse free survival, and distant relapse free survival in patients with either a primary tumor or with a first time local recurrent tumor. Quality of life is a less common outcome used to determine success in sacral chordoma patients. We correlated severe decreases in quality of life to the sacrificing of specific nerve roots.
The role of radiotherapy is still being debated, but an increasingly number of centers advocate the use of routine radiotherapy in combination with surgery. Part 2 of this thesis is devoted to learning more about the effect of radiation on bone. A common complication is sacral insufficiency fractures after pelvic radiotherapy. Conventional radiotherapy (versus intensity modulated radiotherapy), higher dose, and abnormal BMI seem to increase fracture risk. In a CT study we found that trabecular density decreases significantly within weeks after radiotherapy with 50.4 Gy.